accuracy of urinary ngal in predicting cardiorenal syndrome in acute heart failure at emergency - cynderela-hf study

Conditions: Cardiorenal Syndrome

Summary: rationale: heart failure (hf) elevated prevalence in brasil and the world; 20-30% ahf patients develop cardiorenal syndrome (crs) type 1; worsening renal failure (wrf) is a prognostic marker of mortality in acute hf;ngal is a novel biomarker of acute kidney injury released in 2 hours, and addressed in several different clinical scenarios(contrast injury, cardiopulmonary bypass, critical illness. hypothesis: admission ngal predicts crs in ahf patients admitted to the emergency room (er). primary goal: to evaluate the diagnostic accuracy and the best cutoff value of urinary ngal to predict the development of crs type 1 in patients admitted to the emergency room. secondary goals: 1- to evaluate the prognostic impact of ngal on in-hospital adverse outcomes (length of hospitalization, death, institution of renal replacement therapy, use of vasoactive drugs, mechanical ventilation).2- evaluate the prognostic impact of ngal in adverse outcomes in 30 days, 60 days and 6 months (death, rehospitalization, institution of renal replacement therapy).3- identify clinical and hemodynamic characteristics of acute hf that can influence the evolutionary behavior of ngal levels in 48 hours.4- identify the association of drugs commonly used for hf management, which might influence the evolutionary behavior of ngal levels in 48 hours.5-assess the impact of ngal results in clinical decision making. methods: observational, prospective, blinded study. population: acute hf patients admitted to the er of hospital pró cardiaco and hospital antonio pedro - universidade federal fluminense. statistics: convenience sample size (n=180); determination of best cut-off: roc analysis; predictive performance of the cut-off: sensibility, specificity, likelihood ratio, predictive value, accuracy; identification of variables to predict crs: logistic regression and square-qui test; correlations analysis of normally distributed variables: pearson's linear correlation test; mean values for normally distributed variables: mann-wittney test; significance on p\<0,05; intra-assay variation analysis. study chronogram: recruitment: 12 months; results analysis and conclusions: 60 days; manuscript preparation for paper submission: 30 days.

rationale: heart failure (hf) elevated prevalence in brasil and the world; 20-30% ahf patients develop cardiorenal syndrome (crs) type 1; worsening renal failure (wrf) is a prognostic marker of mortality in acute hf; available biomarker shows irreversible damage, late in crs evolution.(creatinine);ngal is a novel biomarker of acute kidney injury released in 2 hours, and addressed in several different clinical scenarios(contrast injury, cardiopulmonary bypass, critical illness...); acute hf patient's risk stratification will allow appropriate resource allocation and establishment of criteria for hospital admission and discharge. hypothesis: admission ngal predicts crs in ahf patients admitted to the emergency room (er). primary goal: to evaluate the diagnostic accuracy and the best cutoff value of urinary ngal to predict the development of crs type 1 in patients admitted to the emergency room. secondary goals: 1- to evaluate the prognostic impact of ngal on in-hospital adverse outcomes (length of hospitalization, death, institution of renal replacement therapy, use of vasoactive drugs, mechanical ventilation).2- evaluate the prognostic impact of ngal in adverse outcomes in 30 days, 60 days and 6 months (death, rehospitalization, institution of renal replacement therapy).3- identify clinical and hemodynamic characteristics of acute hf that can influence the evolutionary behavior of ngal levels in 48 hours.4- identify the association of drugs commonly used for hf management, which might influence the evolutionary behavior of ngal levels in 48 hours.5-assess the impact of ngal results in clinical decision making. methods: observational, prospective, blinded study. population: acute hf patients admitted to the er of hospital pró cardiaco and hospital antonio pedro - universidade federal fluminense. statistics: convenience sample size (n=180); determination of best cut-off: roc analysis; predictive performance of the cut-off: sensibility, specificity, likelihood ratio, predictive value, accuracy; identification of variables to predict crs: logistic regression and square-qui test; correlations analysis of normally distributed variables: pearson's linear correlation test; mean values for normally distributed variables: mann-wittney test; significance on p\<0,05; intra-assay variation analysis. study chronogram: recruitment: 12 months; results analysis and conclusions: 60 days; manuscript preparation for paper submission: 30 days.

Eligibility criteria:
inclusion criteria: * acute heart failure according to the framingham's criteria * informed consent signed exclusion criteria: * acute coronary syndrome * cardiogenic shock * terminal renal disease * transplanted patients * known nephrotoxicity exposure * urinary tract infection * sepsis

Keywords: 1-heart failure 2-acute heart failure 3-acute decompensated heart failure 4-worsening renal function 5-acute kidney injury 6-cardiorenal syndrome